Handheld robotic needle holder training: slower but better.

Abstract

Handheld robotic laparoscopic instruments fill the gap between robotic and conventional instruments, combining the advantages of degrees of freedom and low price. The difficulty and value in learning these new instruments require detailed investigation. Forty novice surgeons with no laparoscopic experience were randomly assigned to two groups: conventional instrument group (Group Conv) and robotic instrument group (Group Rob). The same training protocol was used in both groups: after viewing a standard operation film, laparoscopic suture training was administered using the corresponding instruments. After each training period, surgeons were tested using a force-sensing test platform. Maximum force (MF) and impulse (IMP) of operators through each ring were recorded. Learning curves based on MF and IMP for both instruments were compared. Institutional review board approval is not needed for this study. MF and IMP of both groups decreased with increased training time; the learning curve of Group Conv decreased faster than that of Group Rob. When training time reached 13h, the MF of Group Rob was significantly lower than that of Group Conv (P < 0.05), while IMP showed no significant difference between the two groups. Effective training reduces operator MF and IMP, possibly decreasing damage to tissues with both conventional and handheld robotic needle holders. Group Rob took longer to reach a plateau, but subsequently had lower suture tension than did Group Conv. MF is more sensitive than IMP for measuring performance progress.